Schedule Cg-Dist - Form 48681 - Charitable Contribution Distribution Listing
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2Schedule
Indiana Department of Revenue
CG-DIST
Charitable Contribution Distribution Listing
State Form 48681
R4/ 7-04
Complete this schedule if your organization made charitable contributions of gaming proceeds to other organizations and/or
individuals. Attach to the Form CG-21 Gross Receipts Report, and/or to the appropriate financial reports, Forms CG-8 or CG-9.
Name (Please type or print)
Indiana Taxpayer Identification Number (TID)
Street Address
City
State
Zip Code
County
Recipient's Federal I.D. Number,
Check If This is
Distribution
Name of Recipient to Whom
Amount Contributed
Indiana TID Number or
a Qualified
Contribution Was Made
Date
to Recipient
Social Security Number
Recipient
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(Turn the page)
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See definition on the back
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Parent category: Financial